Abstract Background/Aims Pain is a prominent symptom for people with inflammatory rheumatic diseases (IRDs), with major impacts on their quality of life. Pain assessment underpins its management and is essential to guiding appropriate biopsychosocial care. The extent to which pain assessments are addressed in clinical IRD guidelines - which largely focus on managing disease activity - is unclear. To address this, we conducted a structured review and synthesis of pain assessment recommendations made in IRD clinical guidelines over the last two decades. Methods We searched PubMed and relevant society websites for clinical guidelines on IRD management from 2005-2025. Societies considered comprised: EULAR, ACR, NICE, BSR, British Pain Society, European Pain Federation, GRAPPA, OMERACT, and the International Association for Study of Pain. IRDs considered were rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axSpA), systemic lupus erythematosus (SLE), juvenile idiopathic arthritis (JIA), vasculitis (all forms), and polymyalgia rheumatica (PMR). Drug-specific guidelines were excluded, and disease-specific guideline updates included. Results Sixty-two guidelines were included. Two fifths (n = 25 44%) mentioned that pain should be assessed or endorsed pain as a core outcome domain, one quarter (n = 16 25%) recommended validated patient-reported outcome measures (PROMs) that should be used to measure pain, but only one gave detailed recommendations about how pain assessments should be structured. Of the 16 guidelines that recommended PROMs, 7 recommended VAS, 5 PAS, 2 NRS, 1 ASAS and 1 ASDAS. In RA, 7/14 guidelines recommended assessing pain as part of disease activity, but only OMERACT/ACR suggested validated PROMs to measure pain. In PsA, 4/8 guidelines recommended assessing pain; one recommended a validated PROM (visual analogue scale VAS). In axial SpA, 5/7 guidelines recommended pain assessment with tools like ASAS core set and spinal pain VAS. 1/2 EULAR guidelines on inflammatory arthritis mentioned structured biopsychosocial pain assessments, including the use of VAS/numerical scales. In SLE/vasculitis, 0/13 guidelines mentioned pain assessments. 3/4 PMR guidelines included pain as an outcome measure. BSR and NICE suggested asking about pain at each patient visit and OMERACT recommended tools like VAS/NRS. In JIA, OMERACT measured pain as a core domain and the 2010 BSR/BSPAR guideline recommended frequent pain assessment using age-appropriate validated tools such as VAS or NRS. Separately, three pain society guidelines recommended validated measures (VAS, NRS, BPI, EQ-5D), though none were IRD-specific. Conclusion IRD clinical guidelines rarely provide information on how to assess patients’ pain, despite it being one of their main concerns. Including evidence-based recommendations about how best to assess pain should be considered in future IRD guidelines to improve this common symptom for patients. Disclosure Y. Ravindran: None. N. Sofat: None. D. Sen: None. I.C. Scott: None.
Ravindran et al. (Wed,) studied this question.